Iyersinioz - the sharp antropozoonozny intestinal infection which is followed by toksiko-allergic reaction, differing in a multiochagovost. The fecal and oral way of transfer is characteristic of an iyersinioz. The livestock, rodents and dogs act as the tank of an infection. The incubatory period of an iyersinioz lasts no more than a week. The clinic consists of an all-toxic syndrome, spotty and papular rashes, dispepsichesky frustration; the gepatosplenomegaliya, an artropatichesky syndrome, development of an acute appendicitis, a generalized form of an iyersinioz are possible. The diagnosis is established on the basis of allocation of iyersiniya in various biological circles of the patient.
Iyersinioz - the sharp antropozoonozny intestinal infection which is followed by toksiko-allergic reaction, differing in a multiochagovost.
Characteristic of the activator
Iyersinioz is called by Yersinia enterocolitica bacterium – a mobile gramotritsatelny facultative and anaerobic stick. Iyersiniya perfectly transfer the lowered temperatures, in the refrigerator at 4-6 °C are capable not only to remain, but also to breed on products. (Quite often call "a disease of refrigerators"). Bacteria easily transfer freezing and the subsequent thawing, for a long time remain in water, the soil, but at the same time are sensitive to a sunlight, drying, boiling and chemical disinfectants. Emit to Iyersiniya , cytotoxins and endotoxin.
The tank and source of an iyersinioz are mainly animal: various rodents, livestock (generally pigs), dogs. People can extend an infection, but infection from the person occurs quite seldom. In the cities the infection is generally carried by rodents, their congestions form the epidemic centers of an infection during the periods of flashes. Iyersinioz is given on fecal oral mechanism food and the waterway. Food of an animal origin, insufficiently processed thermally, water sources polluted by excrements of sick animals promote realization of ways of infection. In rare instances the contact and household way of transfer is implemented (as a rule, it is connected with low hygienic culture).
Natural susceptibility of the person to an iyersinioz – low. Healthy people practically do not get sick with clinical forms of an infection. The heavy and manifest current is characteristic of children, persons having the immunodeficiency, chronic diseases promoting the expressed easing of protective properties of an organism. Epidemic flashes of an iyersinioz are quite rare and most often happen at the mass use of the vegetables polluted by microbes.
Classification of an iyersinioz
Iyersinioz is subdivided into a gastrointestinalny, generalized and secondary and focal form. The gastroenteritis, a thermal ileitis and acute iyersiniozny appendicitis belong to a gastrointestinalny form. The generalized form can proceed in the form of sepsis, hepatitis, meningitis, pyelonephritis, pneumonia, and also in the mixed form.
The secondary and focal form is subdivided into iyersiniozny arthritis, myocarditis, enterokolit, a nodal eritema and a syndrome of Reuters. Iyersinioz can proceed in an easy, medium-weight and severe form, get a sharp cyclic, chronic and recidivous current.
Symptoms of an iyersinioz
The incubatory period of an intestinal iyersinioz makes 1-6 days, the clinical picture is usually presented by several syndromes. The all-toxic syndrome which is shown in the form of the fever reaching 38-40 °C, a fever, headaches, the general weakness, an ache in muscles and joints is most often noted. Appetite is reduced, at a heavy current disorders of the central nervous activity can be noted. The feverish period usually to last 7-10 days (considerably being extended in case of a generalized iyersinioz). At a gastrointestinalny form of the general intoxication dyspepsia (nausea, vomiting, diarrhea, belly-ache) usually accompanies.
In rare instances at an iyersinioza the ekzantema appears. Rashes are spotty and papular, melkotochechny or krupnopyatnisty (sometimes ring-shaped), develop on various sites of skin, most often in the lower part of extremities (a symptom of "socks" and "gloves"). Rash can be followed by burning in palms, leaves behind sites of a peeling. At some forms of an iyersinioz the artropatichesky syndrome (artralgiya) is noted. Joints of extremities (brushes, feet, elbow and knee) are painful, edematous, the movements in the affected joints are limited. At a generalized iyersinioz the gepatoliyenalny syndrome (increase in a liver and spleen) can be noted.
In clinical practice the gastrointestinalny form of an iyersinioz most often meets. The disease proceeds like other infectious and toxic damages of intestines, is characterized mainly by displays of intoxication and (in half of cases) dispepsichesky frustration. Intoxication usually precedes, but can develop also along with dyspepsia. Sometimes this form of an infection is followed by rashes, a catarrhal or artropatichesky syndrome. The expressed intoxication can promote development of a gepatosplenomegaliya, and also the moderate polilimfoadenopatiya is sometimes noted (lymph nodes are increased, but are painless and do not lose mobility).
Depending on weight of a current, duration of a disease fluctuates from 2-3 days to two and more weeks. It is long proceeding intestinal gains wavy character, symptoms of dehydration appear. The acute appendicitis or a terminal ileitis at defeat by iyersiniya do not differ on a current from those the pathologies caused by nonspecific flora. These states can both develop independently, and to have secondary character, being result of progressing of gastrointestinalny or other form of an infection.
At a generalized form a variety of symptomatology is noted. An all-toxic syndrome intensive, fever reaches critical figures. In most cases (80%) the artralgichesky syndrome is expressed, the catarrhal phenomena (a sore throat, rhinitis, cough) are noted, for 2-3 day rash on palms and soles can be celebrated (is more rare in other localization). The Dispepsichesky phenomena can arise at the initial stage and seldom remain at the height of a disease. A half of patients notes belly-ache (mainly below from the right), a quarter – nausea, vomiting and diarrhea.
With progressing of an infection the liver and a spleen increase, the current can become wavy and recidivous. The similar symptomatology can accompany the mixed form of an iyersinioz. In case of long bacteremia and an obsemeneniye microorganisms of various bodies and systems symptoms of secondary hepatitis, pneumonia, pyelonephritis, serous meningitis and (extremely seldom) sepsis can appear. At the same time the initial symptomatology can abate, or remain and progress.
The secondary and focal form can turn out to be consequence of any of the above described forms of an infection, usually it develops in 2-3 weeks after the beginning of a disease or in later terms. This form is connected with formation of pathological reactivity and autoimmune defeat of bodies and fabrics. In exceptional cases proceeds without the expressed clinic. Most often iyersiniozny jet polyarthritis meets. Joints of extremities (feet, brushes), more often asymmetrically are surprised usually. Monoarthritises are rare (no more than a quarter of cases). Joints are edematous, skin hyperaemia over them is absent. The course of polyarthritis can become long or chronic, on average duration its 2-3 months.
In 10-20% of cases proceeds in the form of a knotty eritema. Hypodermic small knots are formed on shins, hips and buttocks, painful, large. The quantity can vary from several pieces to two and more than tens. 2-3 weeks later small knots resolve. A syndrome of Reuters are the combined conjunctivitis, uretrit also arthritis. Iyersiniozny myocarditis it is frequent to last till some months, but usually in not severe good-quality severe form, cardiovascular insufficiency does not develop.
The secondary and focal form can proceed in the form of an enterokolit (usually develops at persons with intestinal infections in the anamnesis). Defeat is localized mainly in the top departments of intestines, quite often combined with other options of an infection (arthritises, an ekzantem, a catarrhal syndrome), can be followed by asthenic symptomatology (adynamy) and temperature increase of a body to subfebrilny figures. At an iyersinioza it is possible to carry various limfoadenopatiya, piodermiya, osteomyelitis to rare symptoms. Common feature of jet polyorgan pathologies at an iyersinioza is the wavy current and tendency to vegetososudisty frustration.
Complications of an iyersinioz
Complications of an iyersinioz in view of polymorphism of manifestations and tendency to formation of autoimmune reactions are quite diverse. It can be inflammatory diseases of bodies (myocarditis, hepatitis, cholecystitis, pancreatitis), surgical pathologies (an adhesive disease, intestinal impassability, appendicitis, perforation of a wall of intestines and peritonitis), diseases of nervous system (encephalomeningitis), urinary (glomerulonefrit) also musculoskeletal (arthritises, osteomiyelita) the device.
Diagnostics of an iyersinioz
Allocation of the activator is possible from excrements, blood, bile, urine, a likvor of patients, besides, can be carried out washouts with mucous a pharynx, a phlegm. The activator comes to light in washouts from objects of the environment, objects, from foodstuff. However bacteriological diagnostics demands considerable time (frequent up to 30 days). As the express analysis apply reactions to definition of anti-genes of the activator in biological liquids (by means of RKA, RLA, RNIF, IFA).
Sensitivity of RKA increases at the heavy course and synchronization of process. From 6-7 in the afternoon diseases become positive RA and THRESHING BARN, 5-7 days later make repeated measurement of a caption of antibodies. Consultation of the gastroenterologist, cardiologist, nephrologist or neurologist can be required by the patient with iyersiniozy. At development a complication carrying out the ECG, Ekho-KG, ultrasonography of abdominal organs, etc. is shown.
Treatment of an iyersinioz
In modern clinical practice treat permanently, appointing the prolonged etiotropny means even at easy forms of a disease. Such tactics is caused by the frequency of synchronization of an infection and to development of recidivous character of a current. Etiotropny therapy includes a course of antibiotics and ftorkhinolon, duration for all feverish period and 10-12 days later. Late purpose of medicines (after 3 days of clinical symptomatology) does not guarantee the prevention of complications and synchronization of an infection. A generalized form treat in a complex (appoint medicines of various groups of antibacterial means parenterally), make change of antibiotics throughout a course for prevention of a recurrence.
The complex of nonspecific therapeutic measures is chosen depending on a condition of the patient and the course of a disease. According to indications appoint dezintoksikatsionny solutions (a dextran, colloidal and kristalloidny mixes), antihistaminic medicines, anti-inflammatory groups of nonsteroid means, and if necessary – Prednisolonum (quite often use hormonal resolvents for local application). Vitamin therapy, digestive enzymes, a probiotics for correction of an intestinal biocenosis, and also means for increase in immune protection (immunomodulators, human immunoglobulin) can be shown to patients.
Forecast and prevention of an iyersinioz
Despite a variety of complications and forms of a disease, a current of iyersinioz usually good-quality, lethal outcomes are extremely rare. The iyersiniozny sepsis which is coming to an end with death in half of cases differs in the adverse forecast.
Prevention of an iyersinioz means respect for personal hygiene including hygiene of food, and also sanitary and epidemic control of treatment and prevention facilities and catering establishments and the food industry. A significant measure is control over a condition of water sources. One of preventive measures is deratization of settlements and agricultural grounds.